Detect Cancer Early Programme Board minutes: February 2019

Minutes of the meeting of the Detect Cancer Early (DCE) Programme Board held on 5 February 2019.

Attendees and apologies

  • Cathie Cowan, Chair of DCE Programme Board, Chief Executive of NHS Forth Valley
  • Sami Shimi, Lead Cancer Clinician, NoSCAN
  • Jan Young, Senior Assistant Statistician, Cancer Access Team 
  • Nicola Barnstaple, DCE Programme Director, Cancer Access Team 
  • Diane Primrose, DCE Programme Manager, Cancer Access Team 
  • Margaret Kelly, Cancer Framework Consultant, Scottish Government (Cancer Manager, NHS Lanarkshire) 
  • Gail Lyall, Senior Marketing Manager, DCE, Scottish Government 
  • Garry Hecht, ISD  Valerie Doherty, DCE Clinical Lead, Cancer Access Team 
  • Natalia Calanzani, PhD student, University of Edinburgh 
  • Evelyn Thomson, Network Manager, WoSCAN 
  • Bryan McKellar, NoSCAN (Deputy for Lorraine Cowie) – VC Lisa Fowler, NoSCAN (shadowing Bryan McKellar) - VC 
  • Dr Azmat Sadozye, Clinical Director, Beatson Oncology Centre (representing WoSCAN)
  • Kate MacDonald, SCAN Network Manager Gordon Matheson (Cancer Research UK, representing Scottish Cancer Coalition) 

Apologies from: 

  • Hugh Brown, Chair Scottish Primary Care Cancer Group
  • Sarah Dillon, Screening Policy Manager, Scottish Government 
  • Claire Donaghy, Head of Scotland, Bowel Cancer UK 
  • David Morrison, Scottish Cancer Registry
  • Louise Wilson, Director of Public Health, NHS Orkney 
  • Anne Watson, NES Pharmacy Dean 
  • Lorraine Cowie, Network Manager, NoSCAN 
  • Michael Muirhead, ISD Andy Grierson, Project Manager, Scottish Government 
  • John Quinn, ISD

Items and actions

Item 1. Welcome and introductions

The Board was asked to note a change in membership. Seamus Teahan, Lead Cancer Clinician for WoSCAN has been unable to attend many DCE Programme Board meetings until now due to Tuesday clinic responsibilities. Dr Azmat Sadozye, Clinical Director of Beatson Oncology Centre will now join the group as clinical representation for the West of Scotland. Meanwhile, Evelyn Thomson will also be formally joining the group in her capacity as Regional Network Manager for WoSCAN. 

ACTION: Cancer Access Team to review DCEPB terms of reference, given recent changes to membership and to ensure the Board remains looped into relevant cancer work-streams and programmes. 

Item 2. Note of previous meeting – 18 September 2018 

The Board agreed that any outstanding actions will be picked up through today’s agenda and were otherwise content with the action note.  

Item 3. Cancer Access Standards 

3.1 Cancer Waiting Times (CWT), Jan Young (verbal)

Jan provided an update on Q3 2018 statistics that were published on 18 December 2018. This showed that the 31 day standard was met at 95.1%, a slight increase from 95.0% in the previous quarter and from 94.5% in Q3 2017.  

The median wait from decision to treat to treatment remained at six days. Eight NHS Boards and the Golden Jubilee National Hospital met the standard in this quarter.  

The 31 day standard was met for eight of the ten cancer types. 89.3% of patients were treated within 31 days for urological cancer, a slight increase compared to 88.7% in the previous quarter. 95.7% of patients who were treated for breast cancer were treated within 31 days compared to 95.4% in the previous quarter. 

81.4% of patients started treatment within the 62 day standard. This is a decrease of 3.2 percentage points compared to the previous quarter and a decrease of 5.8 percentage points compared to the same period last year. Two NHS Boards met the 62 day standard (NHS Borders and NHS Lanarkshire) in this quarter. The median wait for a patient to receive treatment was 44 days from urgent suspected cancer referral, a slight increase from 42 days in the previous quarter. 

The next set of cancer waiting times data (Q4 2018) is due to be published 26 March 2019.   

Item 4. Access Action  

In response to the waiting times position that Jan outlined, a few key actions and areas of work that the Cancer Access Support Team is working on were outlined. 

4.1 Endoscopy Action Plan & WTIP 

Nicola Barnstaple Nicola provided an update on the £14 million national Endoscopy Action Plan that is a key part of the overall Waiting Times Improvement Plan and being driven forward by Jean Wright, Diagnostics Lead.  

While the plan was launched in June 2018 Nicola highlighted that it will be published publicly in due course. Gordon Matheson flagged that the Cabinet Secretary, who recently met with the Scottish Cancer Coalition, had promised to share the plan with key third sector organisations before being published. Nicola promised to ensure this was actioned urgently and the Plan was shared following the meeting for comments and input.  

Nicola also provided a general overview of her recent attendance to the WTIP Operational Board meeting to discuss cancer in January 2019. The Board is aware of the priority of cancer, and will be mindful of this when cancer related bids are received from Boards - and recognise the magnitude of work already underway to help improve performance. 

ACTION: Nicola to ensure third sector colleagues have sight of Endoscopy Action Plan prerelease. 

4.2 Cancer Management Framework & Peer Review

Margaret Kelly (verbal) Margaret provided an update on the peer to peer support she’s been offering Boards in recent months.  

Margaret has visited eight Boards to date, for around 3-4 days each time. Following the visit, Boards have been provided with a tailored report of recommendations to improve performance. Margaret outlined a few key themes and observations from visits to date – need to raise awareness of the importance of CWT standards across specialties and teams, pathways require updates, MDTs have to be effective, appropriate escalation necessary and application of Data & Definitions manual is a must. 

Margaret highlighted the fact that she’s working closely with Macmillan to develop a number of tracking education days which will help re-energise the tracking workforce and stimulate networking across Boards.  

Meanwhile, the Cancer Managers Forum has a new Chair and has refreshed it’s terms of reference to ensure best practice is being shared and common challenges and themes are explored collectively, across boundaries. 

The Chair noted Margaret’s important work and asked that ‘key messages’ could be shared with Chief Executives as well as highlighting ‘what else could we do’, to ensure this work remains high on the agenda.  

Meanwhile Kate MacDonald flagged that they have a Regional Chief Executives meeting coming up so Network Managers could be helping to deliver these messages also. Evelyn Thomson mentioned their work in WoSCAN around focusing on optimising MDTs, highlighting the importance of Boards being aligned in looking at some of the recommendations that Margaret is making on a regional level. Val Doherty flagged that some of this work will also link in with the Cancer Waiting Times Recommendations Implementation Group (CWT RIG), which all Cancer Network Managers sit on also.  

The Board was asked to note that Margaret would be presenting at Cancer Research UK’s Early Diagnosis Conference in Birmingham on 11-13 February – a great platform to showcase her invaluable work and efforts to support Boards in improving performance across NHSScotland.  

The Waiting Times Improvement Plan provides an avenue for Boards to tap into to help make Margaret’s recommendations a reality.  

ACTION: Margaret and the wider Cancer Access Team to consider further engagement with Chief Executives to ensure Cancer Framework continues to be a priority.  

4.3 CWT Recommendations Implementation Group

Diane Primrose updated the Board that the first CWT Recommendations Implementation Group met on 29 November 2018. The groups is Chaired jointly between Calum Campbell, Chief Executive of NHS Lanarkshire and Professor Aileen Keel, Director of the IHDP.  

The majority of discussion was around the current landscape, confirming terms of reference and working through the recommendation tracker to flag work already underway to progress the recommendations. This showed that there’s already a vast amount of work underway through existing work streams, such as the Scottish Access Collaborative, to reduce pathway variation and embed smarter triage, where clinically appropriate. 
Several members of the DCEPB have been invited to sit on the group and attendance at the first one was very strong – there’s clear appetite for CWT to be enhanced and patient experience improved. The group will next meet again on Monday 11 March 2019. 

Item 5. Screening update, Sarah Dillon 

Screening colleagues were unable to attend the meeting but have provided the following written update for the Board’s attention:  

Review of Screening

Following the Healthcare Improvement Scotland (HIS) Report Review of the Scottish Breast Screening Programme, published in December 2016, the Cabinet Secretary for Health and Sport commissioned the Chair of the Scottish Screening Committee (SSC) to undertake a review of the delivery and management of national screening programmes in Scotland. 

The Review was established in August 2017, and was led by Dr Hilary Dobson OBE, Deputy Director, Innovative Health Care Delivery and Dr Sue Payne, Public Health Advisor for Screening, Scottish Government. The Report was finalised on 29 October 2018. The Review recognised the scale and complexity of the challenge around national screening programmes, and made a total of 23 recommendations across the themes of Roles and Responsibilities; Commissioning; Quality Assurance; and IT.  

It is not possible for us to take forward all of the review recommendations immediately. It is proposed that a small number of specific recommendations be taken forward, with a view to building more capacity and leadership to progress the remaining recommendations in the medium term.  

On this basis, early priorities for action by Scottish Government include the establishment of a new National Screening Executive function, to provide oversight, at a national level, of all parts of the screening pathway. The purpose of this new function is to address current gaps in accountability, to provide end-to-end performance monitoring and risk management, and to lead incident management and response.


The review recommends this function should be established within a single body, and led by a new Director of Screening. The Scottish Screening Committee and Board Chief Executives Group expressed broad support for this new national oversight function, while recognising some of the challenges that come with structural change.  

This new leadership and oversight function, will then develop an implementation plan for the other more operationally-focussed recommendations.

Bowel Screening 

The introduction of FIT into the Scottish Bowel Screening Programme has performed beyond original expectations. Published information from Information Services Division (ISD) show that:  

* 64% of people returned their test for FIT in the six months since the test was launched. This is the first time the uptake has been better than the target of 60%. This is in comparison to only 56% uptake for Nov 2016 to April 2017 for FOBT.

* Improvements in uptake are highest for men, increasing from 52.6% for FOBT to 61.8% for FIT. Improvements are also highest in the most deprived quintile, increasing from 42.0% to 51.8%.
* Uptake amongst those who have never participated in the programme before (though had the opportunity) has increased from 8.2% to 18.4%.
* FIT also had a higher percentage of patients with a positive result than the FOBT (3.2% vs 2.1%).
* Ever since the Scottish Bowel Screening Programme was launched, uptake has been lower in areas of higher deprivation. The gap between the lowest and highest areas of deprivation was smaller for FIT (20.7 percentage points) than for FOBT (23.6 percentage points).   

Breast Screening

Following the discovery of an issue with the Scottish breast screening invitation system in 2018, all women involved received letters inviting them to breast screening. Any women affected by this incident, and who have been identified as requiring referral to secondary care for further investigation following a mammogram, are being reviewed by a specialist clinical team as a matter of urgency. This work is being led by National Services Division who are liaising closely with the screening service, screening co-ordinators and Clinical Lead. 

Unlike most other screening programmes, where the offer is based on the participants age or a specific recall date, women are currently invited for screening based on the GP practice with which they are registered. This was introduced to minimise travel as a possible barrier to participation.  

The Scottish Screening Committee advise that there is now a clear need to explore options for delivering breast screening in a way that meets the needs of women accessing the service as well as ensuring optimised and effective service delivery.  

Potential change to the system would need to fully consider the impact on inequalities and address known barriers to screening. Any alternative delivery model would almost certainly involve considerable change to the functionality of the supporting IT system and would require a long term strategic implementation plan to be formulated. 

The proposed review will have four key objectives: 

* To review the current Breast Screening Programme in Scotland. 
* To make recommendations on the future delivery of the Programme. 
* To make recommendations on policy direction for the Breast Screening Programme 

* To develop costed options for service redesign for consideration by NHS Boards and Scottish Government 
Scottish Ministers have been briefed on the review of the Scottish Breast Screening Programme and a decision is awaited. 

Cervical Screening

Work is progressing to implement the change to Hr-HPV testing in the Scottish Cervical Screening Programme which is expected to go live from early 2020. The technology allows for possible future developments, including self-sampling, to increase the likelihood of uptake of screening by hard-to-reach groups of women. 

Research shows that self-sampling can help overcome many of the barriers which result in unequal access to screening. A pilot of self-sampling will be scoped in 2019 with a possible launch in summer 2020.  
A successful and hard-hitting cervical screening awareness campaign which first launched in 2017 ran again in January this year via targeted digital platforms and cinema.  
A motion on cervical screening in the name of Monica Lennon MSP was selected for Members’ Business debate on 22 January this year. The debate provided the Minister with the opportunity to update Parliament on the actions underway to increase participation in cervical screening such as supporting the work of charities like Jo’s Cervical Cancer Trust. To enable the charity to expand their reach we are funding their innovative new outreach service targeting women less likely to attend, as well as their Scottish roadshow providing information and support about cervical screening and cervical cancer to high streets and retail parks across Scotland.

Inequalities Funding

To date, over £2.7m from the Scottish Government’s Cancer Strategy has been committed to support innovative projects across the cancer screening programmes targeted at reducing inequalities in screening. The deadline for applications for 2019/20 funding was on the 18th January 2019 and applications are currently being considered.  

The inequalities projects now have a dedicated space on the Knowledge Hub. This is a space for projects and those with an interest in reducing inequalities in access to screening to collaborate, seek peer support and share learning and experiences as programmes grow. A Chair has been appointed to the Screening Inequalities Steering Group, and work is underway to identify the remaining steering group members. 

The last Scottish Screening Committee Development Day on Screening Inequalities took place on 21st February 2019 and the next event is scheduled for 4th April 2019. 

Item 6. DCE LDP Reporting, Gary Hecht

Gary provided an update on the upcoming algorithm changes while providing some reassurance that DCE’s data will still be comparable once these changes come in.  

Gary also updated the Board on a recent request that’s been formally proposed to link some of the available data sets (i.e. screening and DCE) to better understand DCE’s colorectal staging trends, which has caused some confusion in regards to interpretation to date. Jan is working closely with ISD to identify the parameters and variables required for such work.  

Item 7. DCE evaluation, Natalia Calanzani

Natalia presented to the Board what she has been undertaking in recent years, evaluating the first three years of the DCE Programme (2012-2015). The results would be shared at Cancer Research UK’s upcoming national Early Diagnosis Conference in Birmingham.  

Natalia recapped on the methodology, before outlining results and recommendations. The nature of the recommendations were not a surprise for those in the room i.e. consider different ways to target high deprivation communities, a core audience for DCE.  

Diane mentioned that Natalia’s work would be shared with the Cabinet Secretary in due course, along with an update against each recommendation to show how work has progressed across the Programme, past the first three years (which Natalia’s work focused on).   

Item 8. DCE social marketing results, Gail Lyall

Gail took the Board through the recently completed independent evaluation of DCE’s campaign, Survivors. Attitudinal tracking with the core audience – 45+ C1C2DEs showed that, following the campaign there was a:   

  • 50% increase in people agreeing that ‘you regularly hear news stories about successfully treating and surviving cancer in Scotland’. 
  •  20% increase in agreement with ‘it’s worth putting up with the unpleasantness of screening to detect cancer early’. 
  •  21% increase in agreement of ‘more people are surviving cancer than ever before and early detection plays a big part’.   
Gail flagged that, based on these results, the campaign will be back on air in 2019.  

The Board had some discussion around the campaign’s desire to reduce fear. Dr Sadoyze made a valid point in that – if more people are surviving than ever before, this group understandably worries about recurrence in which case we could see fear continue to increase, mirroring survivorship.  

ACTION: Healthier Marketing to consider the role of ‘fear’ in DCE moving forward, and clarify what the Programme hopes to realistically achieve and track.   

Item 9. Scottish Referral Guidelines for Suspected Cancer

The Referral Guidelines for Suspected Cancer were published on 22 January 2019, with QRG packs being distributed from mid-February to GP practices, A&E Departments and Minor Injury Units (MIU) across NHSScotland. 
Alongside the QRG resource is a new patient information leaflet – Your Urgent Referral Explained – and visual map of the Guidelines, which can both be found on the Guidelines resource section 
Boards are now organising primary care education events and generally disseminating the clinically refreshed Guidelines through their networks to ensure patients are being put on the right pathway at the right time.  

Item 10. AOB 

10.1 New tumour group, Diane Primrose

Following an options appraisal exercise, engagement with Chief Executives, a review of latest evidence/statistics and consultation with Regional Clinical Leads, a recommendation was made to the Cabinet Secretary in November 2018 for head and neck to be the next tumour group to be formally introduced to the DCE Programme.  

A revised brief has now been shared with the Cabinet Secretary reinforcing this decision.  

10.2 FIT for triage of symptomatic patients

A national qFIT implementation event chaired by Prof Bob Steele, was held on December 13th 2018 at Surgeons Hall, Edinburgh. This brought together over 40 of colleagues from across the health service, third sector and Government. This was an opportunity for all to come together and share knowledge and data and potentially reach a consensus on what needs to be done differently or better going forward on qFIT symptomatic pilots.   
Nine of the participating twelve Boards delivered a presentation which focused on experiences, data and outcomes from their qFIT implementation pilots. 

qFIT has now also been mentioned in the clinical refresh of the Scottish Cancer Referral Guidelines.  

Quarterly reporting will continue to ensure that Board project teams gather data and information that strengthens the evidence for use of qFIT in the symptomatic population.  

A second national clinical meeting will be arranged in the summer (July) to take stock of progress, analyse the data and further facilitate management of risks. In the interim, a report following the December event will be pulled together while national conversations continue around the possibility of a data warehouse to collect data securely and centrally, enabling more detailed analysis to be undertaken.

10.3 Date and time of next meeting

Dates have been circulated for the whole year – the next meeting is 14 May at 10 am in SHSC. Papers will be circulated closer to the time.  

Diane noted, progress updates from phase one melanoma pilots will be shared with the Board ahead of the next meeting for discussion. Meanwhile, those that have received phase two funding have been invited to attend and present on their projects and work to date.  

10.4 AOB

It was noted with sadness that Dr Sami Shimi would be stepping down from his role as NoSCAN Clinical Lead in due course – the Board thanked Dr Shimi for all his valuable contributions over the years and will mark his departure from the group formally with written correspondence
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